30 Oligoarticular juvenile idiopathic arthritis-associated uveitis

Abstract Background Oligoarticular juvenile idiopathic arthritis (JIA) is a rare inflammatory disease that occur in children under the age of 16. JIA associated uveitis is the most frequent extra-articular manifestation. The uveitis can be sight-threatening and may be burdened with disabling morbidity. The uveitis seen in JIA is chronic anterior uveitis which is always asymptomatic in the initial stages. Aim The purpose of our survey is to report the incidence of uveitis in oligoarticular JIA and to determine the potential risk factors for the occurrence of uveitis in children with oligoarticular JIA. Results We retrospectively evaluated 70 consecutive pediatric patients with oligoarticular JIA in the emergency and outpatient paediatric departement at the children's hospital in Tunisia between January 2005 and December 2021. A total of 12 cases (17.1%) with oligoarticular JIA associated uveitis where identified. The incidence of uveitis in these children was 0.7 cases per year. The uveitis had occurred before the joint manifestations in only one patient. The average time between the onset of symptoms and the occurrence of uveitis was 1.7 years with a maximum time interval of 5 years. Management of JIA-associated uveitis involved use of topical agents in half of our patients and systemic agents in the other half. JIA-associated uveitis has led to ocular complications such as cataracts (n = 5), glaucoma (n = 6), anterior/posterior synechiae (n = 8), and ultimately a visual impairment and blindness (n = 1). Eleven of the twelve patients with uveitis retained acceptable visual acuity. The presence of antinuclear antibody (ANA) has been identified as a risk factor for the occurrence of uveitis (p = 0.03). Conclusion Collateral damage of oligoarticular JIA include growth failure, muscle atrophy and intraocular damage. The main challenge during the management of oligoarticular JIA is the early detection of uveitis. Close cooperation between the rheumatologist and the ophthalmologist is essential to optimize outcome.


Background
Oligoarticular juvenile idiopathic arthritis (JIA) is a rare inflammatory disease that occur in children under the age of 16. JIA associated uveitis is the most frequent extra-articular manifestation. The uveitis can be sight-threatening and may be burdened with disabling morbidity. The uveitis seen in JIA is chronic anterior uveitis which is always asymptomatic in the initial stages.

Aim
The purpose of our survey is to report the incidence of uveitis in oligoarticular JIA and to determine the potential risk factors for the occurrence of uveitis in children with oligoarticular JIA.

Results
We retrospectively evaluated 70 consecutive pediatric patients with oligoarticular JIA in the emergency and outpatient paediatric departement at the children's hospital in Tunisia between January 2005 and December 2021. A total of 12 cases (17.1%) with oligoarticular JIA associated uveitis where identified. The incidence of uveitis in these children was 0.7 cases per year. The uveitis had occurred before the joint manifestations in only one patient. The average time between the onset of symptoms and the occurrence of uveitis was 1.7 years with a maximum time interval of 5 years. Management of JIA-associated uveitis involved use of topical agents in half of our patients and systemic agents in the other half. JIA-associated uveitis has led to ocular complications such as cataracts (n ¼ 5), glaucoma (n ¼ 6), anterior/posterior synechiae (n ¼ 8), and ultimately a visual impairment and blindness (n ¼ 1). Eleven of the twelve patients with uveitis retained acceptable visual acuity. The presence of antinuclear antibody (ANA) has been identified as a risk factor for the occurrence of uveitis (p ¼ 0.03).

Conclusion
Collateral damage of oligoarticular JIA include growth failure, muscle atrophy and intraocular damage. The main challenge during the management of oligoarticular JIA is the early detection of uveitis. Close cooperation between the rheumatologist and the ophthalmologist is essential to optimize outcome.

Background
Juvenile idiopathic arthritis (JIA) is an acquired autoinflammatory disease characterised by arthritis of unknown origin with onset before age of 16 years. JIA comprises a group of heterogeneous diseases further divided into various categories based on shared clinical presentation, laboratory markers, and disease prognosis. Oligoarticular JIA is the most common group of JIA. The region of Africa constitutes a diverse group of ethnicities, socioeconomic conditions, and climates which influence the prevalence of oligoarticular JIA.

Objective
The aim of our study was to assess the incidence of oligoarticular JIA in children and to describe the clinical and evolutionary characteristics of a series of children presenting with oligoarticular JIA.

Results
We retrospectively evaluated 192 consecutive pediatric patients with JIA in the emergency and outpatient paediatric department at the children's hospital in Tunisia between January 2005 and December 2021. A total of 95 cases (49,4%) with oligoarticular JIA were included in the final analysis. The incidence of oligoarticular JIA was 4,11 cases per year. The median age of the onset of symptoms was 56 months (range 6-156) and the ratio of males to females was 0,24. we noticed the presence of a family history of autoinflammatory or autoimmune disease in 15.7% of cases. Children were referred to a paediatrician specializing in rheumatic diseases of the child within a maximum of 3 years. These children were referred by an orthopaedist in 31.4% of cases. 82.9% of children were eutrophic at the time of diagnosis while 11.4% were found to having a failure to thrive. We noted that the knees were the most frequently affected joint (48,6%). Oligoarticular JIA with positive autoantibodies represented 64.3% of our patients. The evolution was marked by the occurrence of uveitis in 17.1% of cases. Of the 95 children followed for oligoarticular JIA, 21.4% had an extensive form and 7.1% are currently at the stage of joint deformation.

Conclusion
The prevalence of JIA in Africa was observed to be towards the lower range of the global estimate. We observed that the most prevalent subtype in our country was oligoarticular arthritis. The incidence of uveitis and anti-nuclear antibody (ANA) positivity were found to be higher as compared with the incidence from other regions. Background Methotrexate (MTX) is the anti-rheumatic drug of choice in juvenile idiopathic arthritis (JIA). Its adverse effects such as intolerance occur frequently, potentially hindering its efficacy Objective To describe the frequency of MTX intolerance and its various adverse effects (AE).

Results
A retrospective study was conducted on the AEs associated with MTX therapy in children diagnosed with oligoarticular juvenile idiopathic arthritis followed-up at the paediatric emergency and outpatient department of the children's hospital in Tunisia between January 2005 and December 2021. Among 95 cases, only 70 patients were included into the study, of whom 55 (78.5%) were girls. The median age at diagnosis was 5.9 years. Of these, 39/70 (55.7%) had required the use of MTX. The use of MTX was early (within the first 6 months after diagnosis) in 61.5% of cases. The initial median weekly dose was 11.4 mg/m 2 . MTX intolerance was noted in 35.8% of cases. Management of intolerance included change in the dose, education and counselling. Adverse events led to MTX withdrawal in only one patient (2.5%). The adverse effects noted during the follow-up were mainly transient increased plasma transaminases (17.9%), gastrointestinal symptoms (10.2%) and cytopenia (7.6%). Impairment of kidney function and behavioural problems were not noted in any of our patients. The medium duration of the treatment was 3.8 years. The evolution was marked by the occurrence of a relapse of the disease after discontinuation of MTX in 14/33 cases (42.4%). The addition of biotherapy was necessary in 10/39 cases (25.6%). Only 7% of children have persistent joint stiffness or deformity.

Conclusion
In JIA, it is important to start effective treatment early to avoid long-term sequelae, such as joint damage. MTX adverse effects such as MTX intolerance occur frequently, potentially hindering its efficacy. To avoid inefficacy, the physician should be timely aware of these adverse events.